{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T14:03:00Z","timestamp":1784901780278,"version":"3.55.0"},"reference-count":26,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"unspecified","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"AstraZeneca AB","award":["ESR-17-13417"],"award-info":[{"award-number":["ESR-17-13417"]}]},{"name":"Colt Foundation PhD","award":["CFPhD\/22\/61"],"award-info":[{"award-number":["CFPhD\/22\/61"]}]},{"DOI":"10.13039\/501100013342","name":"NIHR Imperial Biomedical Research Centre","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100013342","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["085790\/Z\/08\/Z"],"award-info":[{"award-number":["085790\/Z\/08\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"UK Medical Research Council","doi-asserted-by":"crossref","award":["MR\/R011192\/1"],"award-info":[{"award-number":["MR\/R011192\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2026,7,2]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Occupational exposures are contributors to chronic respiratory diseases, particularly in low- and middle-income countries (LMICs), where regulatory policies are limited. We investigated associations between occupational exposures and respiratory outcomes using longitudinal data from the Burden of Obstructive Lung Disease study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed data from 4237 participants across 17 sites, mostly in LMICs. Occupational exposures were assessed by self-report (never vs ever) and the ALOHA+Job Exposure Matrix for vapours, gases, dusts, fumes (VGDF), pesticides, solvents and metals (cumulative exposure). Respiratory outcomes included: forced expiratory volume in 1 s (FEV\u2081), forced vital capacity (FVC), the FEV\u2081\/FVC and respiratory symptoms. Associations were examined using multilevel linear and logistic regression models adjusted for age, sex, smoking, pack-years, education, body mass index and baseline FVC. We further explored sex differences and non-linear relationships for symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over a median 10 years of follow-up, FEV\u2081\/FVC decline was associated with moderate (\u03b2=\u20131.34; 95%\u2009CI \u20132.32 to \u20130.35) and high (\u03b2=\u20131.79; 95%\u2009CI \u20133.33 to \u20130.20) exposure to VGDF and low (\u03b2=\u20131.11; 95%\u2009CI \u20132.11 to \u20130.08) and high (\u03b2=\u20132.16; 95%\u2009CI \u20134.08 to \u20130.24) exposure to pesticides. Increased risk of wheeze was associated with moderate (Relative Risk (RR) =1.45; 95%\u2009CI 1.05 to 2.15)\u2009and high (RR=1.89; 95%\u2009CI 1.100 to 3.26)\u2009exposure to pesticides. Associations did not differ by sex. There was weak evidence of non-linear exposure\u2013response relationships and no associations with solvents or metals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      A significant decline in FEV\n                      <jats:sub>1<\/jats:sub>\n                      \/FVC was associated with exposure to VGDF and pesticides. Increased risk of wheeze was also associated with exposure to pesticides. These findings underscore the need for continued monitoring in high-exposure settings, particularly in LMICs.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2026-004213","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T13:15:27Z","timestamp":1784898927000},"page":"e004213","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Association of respiratory health with occupational exposures in the Burden of Obstructive Lung Disease (BOLD) cohort: a multinational longitudinal study"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6351-2383","authenticated-orcid":false,"given":"Valentina","family":"Quintero-Santofimio","sequence":"first","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jixuan","family":"Ma","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, UK"},{"name":"Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Potts","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Kromhout","sequence":"additional","affiliation":[{"name":"Institute for Risk Assessment Sciences, University of Utrecht, Utrecht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Feary","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5093-6980","authenticated-orcid":false,"given":"Christer","family":"Janson","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8165-7236","authenticated-orcid":false,"given":"Magnus","family":"Svartengren","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahesh","family":"Padukudru Anand","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, JSS AHER, JSS Medical College, Mysore, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rain","family":"J\u00f5gi","sequence":"additional","affiliation":[{"name":"Lung Clinic, Tartu University Hospital, Tartu, Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6773-9876","authenticated-orcid":false,"given":"Thorarinn","family":"G\u00edslason","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Iceland, Reykjav\u00edk, Iceland"},{"name":"Department of Sleep, Landsp\u00edtali - The National University Hospital of Iceland, Reykjav\u00edk, Iceland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay Kamlakar","family":"Juvekar","sequence":"additional","affiliation":[{"name":"Vadu Rural Health Program, KEM Hospital Pune Research Centre, Pune, India"},{"name":"Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. 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